Showing papers in "International Journal of Research in Dermatology in 2021"

An overview of skin disorders in under-fives over a ten-year period in a tertiary institution in South: South, Nigeria

Abstract: Background: Skin disorders can be a significant cause of distress to both children and their care-givers. The scope of prevalent skin disorders differ from one country to the other. Therefore an insight into the occurrence, patterns and distribution of skin disorders in a target group will be beneficial to inform care and provide support that is relevant to that target population. The aim of this study is to determine the skin problems prevalent amongst children that are five years and below managed at the University of Port Harcourt Teaching Hospital, Alakahia, Nigeria. Methods: This was a retrospective cross sectional study of children five years and below that visited the dermatology outpatient clinic at the University of Port Harcourt Teaching Hospital, Alakahia between the period of January 2006 and December 2015. Results: There was equal ratio of male to female patients with slight female preponderance. The eleven most common lesions were papular urticaria, atopic dermatitis, scabies, warts, vitiligo, molluscum contagiosum, tinea corporis, impetigo, seborrhoeic dermatitis, pityriasis rosea and tinea capitis. Conclusions: Skin disorders are common among children under five years. Allergic skin disorders, bacterial, viral and fungal skin infections, skin infestation (scabies) and pigmentary disorders (vitiligo) are major skin manifestations in this study.

Clinical correlation of foot eczema and patch test: a cross sectional study from South India

Abstract: Background: Foot eczema is caused by several exogenous or endogenous factors acting alone or in combination. Leather, rubber and adhesive components are the most common allergens. Patch test is performed to find out the allergen which helps clinician in subsequent patient management and improving the prognosis. Methods: Total 50 patients with foot eczema were evaluated and patch test was performed with Indian standard series over 18 months period in a tertiary hospital in South India. Results: Out of 50 patients 32 (64%) were females and 18 (36%) were males. Younger age group was mainly involved (second decade). An atopic back ground and seasonal exacerbation were contributory in many. Patch test was positive in 39 (78%) patients. The forefoot was predominantly involved part in 56% followed by dorsal aspect alone of the foot. Scaly plaque was the predominant morphological pattern seen in 25 (50%). Maximum number of patients (24%) showed positive reactions to potassium dichromate and the minimum (2%) to neomycin sulphate. Conclusions: Though rubber and rubber chemicals were the common sensitizers causing foot eczema worldwide, our study found potassium dichromate to be the most common sensitizer which is one the components used in leather tanning and is a constituent of cement, soaps and detergents.

Comparative study of efficacy of minoxidil versus minoxidil with platelet rich plasma versus minoxidil with dermaroller in androgenetic alopecia

Abstract: Background: Androgenetic alopecia is characterized by progressive hair loss and is recognized as having significant psychological effects on affected patients with a negative impact on QOL. Drug therapies specifically approved by FDA for treating androgenetic alopecia (AGA) are limited to minoxidil and finasteride. There are limited three arm studies comparing treatment modalities in AGA, hence we undertook this study to compare the 3 most common, affordable therapeutic modalities used currently in AGA and their effects. Methods: This is a prospective comparative parallel group interventional study. 90 subjects recruited into 3 groups, group A treated with minoxidil alone, group B with minoxidil and dermaroller and group C with minoxidil and platelet rich plasma (PRP). Results: At the end of 5 months 50% patients in group C showed moderate improvement which was found to be superior to the other treatment groups. On the basis of global photographs secondary efficacy analysis was done and all arms were found to have slight improvement. Dermoscopic analysis done at baseline and 5 months showed that group C showed maximum improvement. Pain was the most common side effect noted in group C while pruritus and seborrheic dermatitis was seen more in group A. Conclusions: Our study showed best results in patients treated with PRP and minoxidil. They have emerged as new non-surgical treatment modalities for AGA, with minimal side effects, good safety profile and patient satisfaction. There are limited three arm studies comparing the efficacy and side effect profile of these 3 modalities in AGA.

Evaluation of serum ferritin, vitamin B12 and vitamin D levels as biochemical markers of chronic telogen effluvium in women

Abstract: Background: Diffuse hair loss is a common complaint encountered by dermatologists in clinical practice and can be alarming to the patients. Chronic telogen effluvium (CTE) is characterized by an abrupt onset of diffuse loss of scalp hair persisting for more than six months, predominantly affecting healthy women in their fourth to fifth decade of life. Although CTE is considered to be associated with various nutritional deficiencies, currently the evidence to substantiate this assertion is conflicting. Methods: A cross-sectional study was conducted on 100 adult non-pregnant women with CTE to document serum ferritin, B12 and vitamin D levels in an attempt to validate their role as biochemical markers using Statistical package for social sciences (SPSS) version 25:0 and Fisher’s exact test. Results: Mean ferritin level was 31.17 ng/dL. 23% patients had serum ferritin levels lower than the normal range (13-150 ng/dL). Vitamin D levels (normal range 5.2-60.4 ng/ml, mean 21.41 ng/ml) were low (deficiency range) in 2%. Vitamin B12 levels (normal range 191-663 pg/ml, mean 239.79) were low in 35.7% patients. Other parameters like duration, family history, past history of treatment did not demonstrate any statistically significant correlation. Conclusions: Our study detected low levels of serum ferritin and vitamin B12 in approximately one-fourth and a third of females with chronic telogen effluvium respectively with vitamin D deficiency found in only a small proportion. Although a statistically significant correlation could not be established between these nutrients and participant age or other parameters; we concur with most authors who recommend that all females with diffuse hair loss deserve a thorough screening for nutritional deficiencies to facilitate prompt recognition and timely supplementation.

A study of clinical profile and quality of life in patients with scabies

Abstract: Background: Scabies is an ectoparasitic dermatosis caused by Sarcoptes scabiei and is a public health issue in all countries regardless of socioeconomic status. Scabies can lead to stigmatization, depression, insomnia, and may significantly affect the quality of life. The aim of the study was to find the demographic profile, clinical morphology and quality of life in patients suffering from scabies. Methods: This was a prospective, non-interventional, hospital-based cross-sectional study. Adult patients with scabies reporting to the dermatology department were enrolled in the study. Demographic details, clinical findings, past history and family history was recorded in a proforma. Questionnaire about quality of life was given to the patients and a detailed analysis was done. Results: A total of 120 cases of scabies were enrolled in this clinical study. The most affected age group was between 18 and 30 years. Most common site involved was interdigital spaces (83%) followed by genitalia (48%) and abdomen (42%). The most common lesion was excoriation (91%) followed by papule (88%) and nodules (33%). Out of 120 patients, 111(92%) patients experienced difficulty in working at the work place, 83.3% of patients had feeling of embarrassment, social relationship was affected in 82.5% of patients. Majority of the patients (38.5%) had mild impairment of quality of life. Conclusions: Feeling of embarrassment, difficulty in work place, social stigmata and depression were frequently observed in patients with scabies. In our study scabies mildly affected the quality of life.

Study on prevalence of Frank's sign in cardiac patients in a tertiary care centre, Kanyakumari district

Abstract: Background: Despite its identification over 40 years ago, very few dermatologists are aware of the relevance of Frank’s sign as a cutaneous indicator of coronary artery disease. Aim was to find out the prevalence of Frank's sign among cardiac patients attending a tertiary care centre in Kanyakumari district. Methods: This was a cross-sectional case-control study involving 270 patients, out of which 200 patients with proven CAD (by angiography) and 70 patients without evidence of CAD of more than 40 years of age, in cardiac ward as well as patients attending Cardiology and dermatology OPD in Sree Mookambika Institute of Medical Sciences, kanyakumari during a period of 5 months from August 2020 to December 2020. The data compiled included age, gender, presence of CAD, presence of DELC, grade of DELC, and laterality. Results: DELC was present in 109 cases (40.3%) out of which 92 cases (34 %) had CAD and in 17 cases (6.3%) were without CAD, which was statistically significant (p<0.05). Conclusions: There have been very few studies evaluating the frequency of DELC in South Indian patients with CAD. According to results of the present study, DELC was significantly associated with CAD. DELC was an important dermatological indicator of CAD with a moderately high specificity (75%) and positive predictive value (84%), but had a low sensitivity (46%) and negative predictive value (33%).

Clinical and epidemiological characteristics and hormonal profile of adult females with acne vulgaris: a cross-sectional study from a tertiary care hospital

Abstract: Background: To study clinical and epidemiological characteristics and hormonal profile of adult females with acne Methods: Adult female patients of >25 years of age with acne were enrolled. Demographic profile, habits, location of acne lesions, associated disease and acne flare association with menstrual cycle were noted. Prevalence of abnormalities in testosterone, dihydroepiandrosterone-sulfate (DHEAS), prolactin, luteinizing hormone (LH), follicle stimulating hormone (FSH), LH:FSH ratio, anti-mullerian hormone (AMH), and serum insulin were noted. Ultrasound (abdomen and pelvis) was performed for screening the presence of any abnormality. Results: Fifty one patients [mean (SD) age 30.96 (4.93) years] were included in the study. Thirty six (70.59%) patients had persistent type of acne. Grade 2 acne was present in 40 (78.43%) patients. Oily skin was seen in 27 (52.94%) patients. Hirsuitism and menstrual irregularity was present in 24 (47.06%) and 13 (25.49%) patients respectively. Pigmentation and scarring was present in 27 (52.94%) and 35 (68.63%) patients respectively. Acne lesions were seen on cheeks in 36 (70.59%) patients. Eight (15.69%) patients had elevated testosterone. DHEAS and prolactin levels were normal in all patients. Elevation of LH and decreased FSH levels were seen in five (9.80%) and three (5.88%) patients respectively. Five (9.80%) patients had elevated LH:FSH level. Raised insulin level was seen in 8 (15.69%) patients. Conclusions: Derangement of hormonal profile is not very common among adult female patients with acne. However, in some patients laboratory markers of hyperandrogenism are seen.

A study on the cutaneous manifestations of patients with internal malignancy attending a cancer center in Kanyakumari District

Abstract: Background: Cutaneous metastasis from an internal malignancy is rare and usually occurs at the later stages. Cutaneous changes may also be the presenting feature of some underlying malignancies. To determine the frequency of cutaneous manifestations in cancer patients attending the Cancer centre of Sree Mookambika Institute of Medical Sciences, Kanyakumari. Methods: This was a prospective hospital-based study. 218 patients with malignancies involving various organs, attending the Cancer Centre of Sree Mookambika Institute of Medical Sciences, Kanyakumari, were recorded for a period of 6 months from October 2020 to February 2021. Approval from the Institutional research ethical committee was obtained. Results: In our study, the most common non-specific cutaneous manifestation was generalized pruritis, observed in 17.88% of the patients, followed by acquired ichthyosis in 12.38% of the patients, and herpes zoster in 11.46% of the patients. Specific cutaneous manifestations included cutaneous metastatic infiltrates, observed in 5.04% of the patients. Conclusions: Skin metastases may herald the recurrence of a malignancy after treatment and usually indicate a poor prognosis.

Fractional erbium-YAG laser vs platelet rich plasma in acne scar: a comparative study

Abstract: Background : Facial acne scar is a common complication of acne vulgaris leading to social isolation, lack of self-confidence and depression that warrants multiple treatment approach. In recent years, fractional erbium-yttrium aluminum garnet (er-YAG) 2940 nm laser and platelet-rich plasma (PRP) have been used independently or in combination with other resurfacing modalities in treating acne scars with variable outcomes. The objective of this study is to compare the therapeutic responses and safety of fractional erbium-YAG 2940 nm laser and platelet-rich plasma in atrophic post acne scars. Methods : Patients were randomly divided into two groups (30 each), receiving six sittings of fractional er-YAG laser and PRP every month. Response was evaluated 4 weeks after each treatment session using Goodman and Baron qualitative acne scar grading system, photographic assessment by 2 blinded dermatologist and patients own satisfaction. Results : Both treatment modalities showed improvement of acne scars, but the improvement with fractional er-YAG laser (27% marked and 70% moderate response) treatment was higher in comparison to PRP (10% marked and 67% moderate response) in terms of acne scar grade severity (p=0.33). Similar results were obtained on photographic assessment (p=0.015 and 0.021), and patient’s own satisfaction (p=0.011), respectively. Pain and stinging score were lower in er-YAG group while down time for same was shorter in PRP. Conclusions : Both er-YAG laser and PRP showed significant improvement in atrophic acne scar while former showing slightly superior response with lesser adverse effects.

Literature review: manifestation of skin lesion on COVID-19

Abstract: New cases of pneumonia, which spread rapidly and are deadly, have spread throughout the world. This disease is known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or corona virus disease 2019 (COVID-19) with a viral etiology in the form of novel coronavirus 2019 (2019-nCoV). This disease has extensive clinical manifestations starting from the lungs, hematology system, heart, nerves, reproduction, and the skin. The thing to be aware of is that the skin manifestations in the form of atypical lesions are often found in COVID-19. Common skin manifestations on COVID-19 are erythema-edema with vesicles or pustules (pseudo-chilblain), vesicular eruption, maculopapular rash, urticaria, and livedo lesion. This literature review discusses comprehensively what kind of skin lesions can be suspected of being part of a COVID-19 infection. This literature review is useful for increasing the awareness of doctors about COVID-19 infection and may help in early diagnose of COVID-19 infection and prevent further transmission.

Cutaneous manifestations in patients with chronic kidney disease on hemodialysis

Abstract: Background: Chronic kidney disease (CKD) is associated with several cutaneous manifestations as a result of CKD per se, underlying disease(s) leading to it or the treatment thereof. Cutaneous manifestations get altered following hemodialysis. We studied the prevalence of various dermatoses and the effect on pruritus in patients with CKD on hemodialysis. Methods: Seventy-three patients with CKD having at least one cutaneous manifestation undergoing hemodialysis in Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune were included. Results: Sixty-four (87.67%) of the participants belonged to the age group of 40-69 years; 28 (38.35%), to the sixth decade. The male to female ratio was 1.8:1. Forty-eight patients (65.75%) suffered from diabetes mellitus, 37 of these also from hypertension. Xerosis (72.6%), pallor (65.8%) and pruritus (60.3%) were the common manifestations. The intensity of pruritus remained unchanged in 82% of those affected. Nail changes were seen in 47.9% cases (half-and-half nail, 19.2%; subungual hyperkeratosis, 11%; leukonychia, 6.8%; melanonychia, 6.8%; Beau’s lines, 4.1%). Infections were observed in 32.8% cases (superficial mycoses, 19.2%; bacterial, 6.8%; scabies, 4.1%; viral, 2.7%). Dyspigmentation was documented in 30.1% (hyperpigmentation, 21.92%; yellow tinge, 8.22%), hair changes in 23.3% (sparse scalp hair,16.4%; lusterless hair, 6.9%), acquired perforating dermatoses in 19.2%, and arteriovenous shunt dermatitis in 2.7% cases. Conclusions: Xerosis was the commonest finding and pruritus, the commonest symptom; the intensity of the latter remained largely unaffected by hemodialysis. Half-and-half nail was the most common nail change and superficial mycoses, the most common infection.

Unilateral morphea following unilateral vitiligo: a rare occurrence

Abstract: Morphea and vitiligo are two different conditions for which etiology is unknown. Many pathogenic mechanisms have been postulated for these two conditions, of which autoimmune mechanism is common to both. We here by present a case of a 36 years old female with occurrence of unilateral morphea following unilateral vitiligo.

Zosteriform cutaneous leiomyoma: a case report

Abstract: Cutaneous leiomyomas are rare, benign soft tissue tumors arising from smooth muscles of the skin and comprise of three distinct subtypes, namely piloleiomyoma, angioleiomyoma and genital leiomyoma. Piloleiomyomas can present as solitary form, multiple disseminated and zosteriform or segmental forms. Cutaneous leiomyomas are rare, of which zosteriform leiomyoma is not commonly encountered. Here we report an uncommon case of Type I zosteriform cutaneous leiomyoma in a middle-aged individual which was confirmed on histopathology. Patient was further started on nifedipine with significant symptomatic improvement. The patient is planned for surgical excision and long-term follow in view of its association with aggressive renal malignancy.

A rare case of primary cutaneous diffuse large B cell lymphoma, leg type with metastasis

Abstract: Primary cutaneous diffuse large B cell lymphoma, leg type (PCDLBCL-LT) is a rare and aggressive type of primary cutaneous B cell lymphoma (PCBCL), which represents 10-20% cases of PCBCL. It has a 40-50% recurrence rate and 5 year survival rate of 50%. Here, we present a case of an 86 year old female who presented to us with complaints of slightly tender annular plaques with an oedematous base present over bilateral lower limbs and pitting oedema. Histopathological examination from the annular lesion showed normal epidermis, grenz zone and a dense lymphoid infiltrate involving almost the entire dermis. Immunohistochemistry confirmed histological findings, atypical cell were positive for CD20 and MUM1 protein with focal expression of BCL 6 which is rare. Based on the above findings, we made a diagnosis of diffuse large B cell lymphoma-leg type and started her on palliative radiotherapy. As PCBCL-LT is rare and aggressive lymphoma, we present this case to review literature and summarise its clinical features.

Effectiveness and safety of a combination of sun protection and depigmentation agent in the treatment of epidermal hyperpigmentation

Abstract: Background: Medication adherence is recognized as a worldwide public health problem. As a multi-modality approach with sun protection and depigmentation is quintessential in patients with epidermal hyperpigmentation, a combination of day and night cream may be prudent for long-term improvement and compliance. Aim of the current investigation was to assess treatment outcomes and medication compliance in patients with epidermal hyperpigmentation using day and night cream in a combi-kit packaging (Melaglow day and night TM combi-kit). Methods: Sixty patients (18-45 years) with epidermal pigmentation were enrolled in this 12-week study. Treatment effectiveness was determined by melanin index/erythema measure (dermacatch), extent, depth and density of pigmentation (fotofinder), and clinical/dermoscopic aspects (grade-1: 75% reduction in the amount of epidermal pigment), safety, satisfaction, and compliance were assessed. Results: Out of 60 patients, 52 completed the study. The overall percentage of melanin and erythema improvement was 22.51% and 13.85%, respectively. Based on fotofinder images, 36.54% had grade-2, 34.62% had grade-3, 15.38% had grade-1, and 13.46% patients had grade-4 improvement. Based on the photographic images, 40.38% had grade-2, 32.69% had grade-3, 17.31% had a grade-1, and 9.62% had grade-4 improvement in skin color. All patients agreed that combi-kit helped in remembering and adhering to treatment. Most patients were satisfied with the treatment (84.62%), with compliance rate of 97.72%. No adverse events were reported. Conclusions: Combi-kit containing day and night cream (Melaglow day and night TM combi-kit) was safe and effective in the treatment of epidermal pigmentation, ensuing treatment compliance, and patient satisfaction.

Onychomycosis in onychodystrophy: a hospital-based clinico-mycological study

Abstract: Background: Onychomycosis and onychodystrophy are both characterised clinically as disruption of nail plate characterised by thickening, disfiguration and discolouration. Onychomycosis in onychodystrophy is a diagnostic challenge. Similarly, onychodystrophy could also be treated unwarrantedly for fungus. Hence this study was carried out to determine the prevalence of onychomycosis in patients with onychodystrophy and to study the risk factors associated with the same. Methods: This descriptive study was done in 50 patients with onychodystrophy attending DVL OPD in a tertiary care hospital. After getting informed consent the nails were cleansed with absolute alcohol and nail clipping was taken for KOH and culture. The results were entered in a master sheet and analyzed. Results: Onycholysis, onychomadesis, chromonychia, thickened nail plate and loss of cuticle were the common features observed. Culture from 13/50 (26%) patients were found to be positive for fungal growth. In 13 patients with onychomycosis, 5 patients belonged to more than 50 years, seven patients (53.8%) were housewives. Three patients with onychodystrophy had psoriasis of which 2 (15.4%) patients proved positive for onychomycosis . Aspergillus niger 10 (76.9%) was the most common organism followed by Rhizopus 2 (15.4%) patients and 1 (7.7%) patient with Geotrichium candidum . Conclusions: We concluded that prevalence of onychomycosis in patients with onychodystrophy was 26%. Male gender, age >50, household activities and wetworks were associated risk factors of onychomycosis. Since clinical diagnosis of onychomycosis in onychodystrophy is difficult, appropriate lab investigations like KOH mount and fungal culture should be made mandatory to enable better patient care and clinical outcome.

Chronic urticaria: a clinico-etiological study and autologous serum skin test role in chronic idiopathic urticaria

Abstract: Background: Appearance of wheals daily for more than six weeks is chronic urticarial (CU). No cause is identified in about 50-70% of chronic urticaria patients and are labelled as chronic idiopathic urticaria (CIU). The aim of the present study is to study the clinical and etiological pattern of chronic urticaria and to find out the incidence of autoimmune urticaria by performing autologous serum skin test (ASST) in patients with CIU. Methods: This was a cross sectional study enrolling 100 chronic urticaria patients satisfying including and excluding criteria. The study was done for a period of 1 year. ASST was done in all the CIU patients after recording detailed history, complete physical and systemic examination. Results: Most of the patients (33%) were in 21-30 years age group with female preponderance (66%). Students (38%) followed by house wives (27%) were majorly involved. 21% patients had history of atopy and 8% had abnormal thyroid function tests. Causative factors noticed in 46% patients and remaining were idiopathic (54%). Infections (32.6%) constituted the major etiological factor followed by physical urticaria (30.4%), food (23.9%), medication (11%) and inhalants (2.1%). In infective agents, 46.6% were bacterial followed by helminthic (33.3%). In 29.6% of CIU patients, the ASST was positive indicating auto-immune urticaria. Conclusions: The etiology cannot be identified in most number of patients and hence they were labelled as CIU and the common causative agents observed were infections followed by physical urticaria, food and medication. ASST is considered as the relevant screening test to detect autoimmune urticaria.

Study of clinico-epidemiological profile of leprosy patients at tertiary care center

Abstract: Background: Leprosy is often mentioned as the oldest disease known to man, the origins of which are lost in the mists of antiquity. In spite of having been declared eliminated in December 2005 from India as a public health problem, India has still 60% of the entire global case load. Methods: A total of 60 Leprosy patients belonged to Ujjain and its adjoining districts, attending the outpatient department of dermatology at R.D Gardi medical college, Ujjain (M.P.). Over a period of 1 year i.e. January 2019 to December 2019 constituted the subject material for study. The data was analysed for clinico-epidemiological characteristic and relevant investigations were done. Results: A total of 60 patients attended the leprosy clinic during the study period. Maximum number of patient belonged to age groups of 21-40 years. Male preponderance with M:F ratio was 3:1. Family history was seen in 3 patients (5.0%). 73.3% patients were from rural area. Borderline tuberculoid (19 patients) was commonest clinical presentation and 2 cases of childhood leprosy were recorded. Conclusions: The present study gives a general picture about the current trends of Leprosy in this particular region and highlights the importance of clinico-epidemiological profile and relevant investigations. This study emphasizes the need of spread of awareness about the disease, facilities for investigation and early diagnosis.

Practice pattern and use of a novel skin moisturizer containing skin barrier therapy in patients with atopic dermatitis: a cross-sectional survey among dermatologists in India

Abstract: Background: Atopic dermatitis is considered as the most common chronic, inflammatory dermatological disorder. Skin barrier dysfunction represents an early pathology of this condition. Various factors contribute to development of such defects. Skin moisturizers remain the mainstay of therapy for AD along with other treatment modalities. Methods: Dermatologists across India were administered a questionnaire consisting of questions related to number of the patients seen with AD every week and their clinical experience regarding the use of novel skin moisturizer containing skin barrier therapy for the management of AD. The responses were analysed as number and percentages. Results: A total of 1605 patients were included in this survey. The complete responses were obtained from a total of 58 dermatologists. The majority (98%) of the dermatologists found the overall efficacy of novel skin moisturizer (Atoderm Intensive Baume) in AD patients as ‘satisfactory’. Atoderm Intensive Baume was found as efficacious in improving various parameters of AD such as skin dryness, severity of pruritus, inflammation, insomnia, itching, and urge to scratch. It was also well tolerated. It plays an important role in the repair of damaged skin barrier caused by AD. Conclusions: This survey findings indicated that novel skin moisturizer (Atoderm Intensive Baume) is a preferred formulation by dermatologists across India for the management of AD with proven efficacy and safety.

Awareness about medical ethics among undergraduates after introduction of humanities in curriculum

Abstract: Background: Modern day medicine is full of ethical challenges. A structured training in ethics can help doctors in choosing the best course of action during an ethical dilemma. It will be interesting to explore the knowledge and aptitude regarding bioethics in medical students who are already undergoing structured modules on humanities. Methods: A cross-sectional study was done involving final year part I, final year part II medical students and interns using a validated semi-structured self-administered questionnaire. Questions were predominantly about doctor patient relationship which could be assessed using Likert scale. Results: Acceptable response of over 70% was seen only in response to two questions, both on respect for person. Majority of students did not have a clear concept about consent, privacy and confidentiality. However, most of them gave acceptable response to respecting patient and his wishes. There were many fence sitters in response to the questions regarding paternalistic attitude of doctors and physician autonomy. Majority of students did not give acceptable response in questions pertaining to beneficence and justice. No significant difference was seen between the various phases of medical education. Conclusions: The students were not clear about most aspects of doctor patient relationship like physician autonomy, confidentiality and consent. We need to revamp our teaching to increase understanding of ethics among our medical students.

Recurrent pyogenic granuloma within a port wine stain

Abstract: Pyogenic granuloma (PG) is a common vascular growth usually seen on the face and extremities following trauma, drugs like retinoids, antineoplastic agents or pregnancy. PG and port-wine stain (PWS) represent different types of vascular lesions that may rarely occur in association. PG arising in a PWS is usually reported following trauma, pregnancy or laser treatment of PWS. Any growth in a long-standing vascular lesion creates panic in the patient and a challenge to the physician, especially in the head and neck area. We report a case of recurrent PG emerging de novo in three different locations within the same PWS in a 24 year old male. A review of literature about the coexistence of both conditions is presented here, together with dermoscopic features.

Familial median canaliform dystrophy of heller affecting multiple nails: a rare clinical entity

Abstract: Median canaliform dystrophy (MCD); first described by Heller in 1928 is characterized by a midline or paramedian split in the nail plate. Mostly idiopathic, some identifiable causes include habitual picking of the nails, oral isotretinoin use and positive family history. The familial occurrence of MCD has rarely been described. Till date, no therapy has proven to be consistently successful in effectively managing the condition. Commonly utilized treatments have been intralesional triamcinolone acetonide injections into the dystrophic nail, topical 0.1% tacrolimus ointment and topical tazarotene 0.05% ointment. Despite available treatment options, the condition has a tendency to recur. Here; we report a case of a 14‑year‑old male presenting with familial MCD affecting multiple finger and toe nails.

Clinico-epidemiological study of chronic leg ulcers in a tertiary care referral center from Tamil Nadu, India

Abstract: Background: Leg ulcer is a common ailment of elderly presented with complex dermatological conditions. It may occur as a sequel to infection, malignancy, adverse drug reaction, trauma and hematological disorders. The paucity of data on the prevalence and outcome of the chronic leg ulcer in India served as a basis to conduct this clinico-epidemiological study. To study the prevalence of leg ulcers in a tertiary care referral hospital. Methods: In this cross-sectional study, 100 patients with leg ulcer attending the dermatology OPD at Madras medical college, Chennai, were enrolled after obtaining their consent. Detailed case history of each patient was recorded. Routine clinical investigations, Doppler study and culture were done to detect associated complications. In this study, 58 males and 42 females, with the mean age of 42.01±14.302 years, mean duration of leg ulcer of 17.79±29.87 months were recruited. Results: Venous ulcer (37%) was the most prevalent type of leg ulcer recorded in our study. Doppler study revealed that the 31% of venous ulcers patients developed perforator incompetence. Staphylococcus aureus was the major microbe isolated from the lesions (27%). Conclusions: Chronic leg ulcers are very common in elderly patients and venous ulcer being the most common. Doppler is an effective tool for the assessment of disease severity of venous ulcers and aided in offering the adequate management of the disease. Diagnosis of underlying causes such as pyoderma gangrenosum, autoimmune diseases, malignancies and bacterial culture from the wound will be helpful for the management of the disease.

Hair colouring: what a dermatologist should know?

Abstract: Hair is an important part of body and a major factor in self-image. A wide variety of hair cosmetic preparations are available and are used regularly by most of the world’s population. Hair colouring is one of the commonly done procedure. However, any chemical treatment, normal grooming habits and environmental exposure can produce changes in hair texture or hair breakage. It is necessary for a dermatologist to know the basis of hair colouring, the procedure and the possible side effects it can cause. Also post colour care is also to be known about to prevent further damage to treated hair. This article explains the basic chemistry and mechanism involved in hair dyeing and the basic facts a dermatologist should know.

Paint brush hair: a case report

Abstract: Trichorrhexis nodosa (TN) is an hair shaft disorder presenting with whitish nodes all over the hair (diffuse form) or localized to an area (localized form) and could be either congenital or acquired. TNis ultimately a response to physical or chemical trauma that leads to formation of nodes along the hair shaft. Here, we reported a case of TNof the beard, diagnosed clinically and through trichoscopy. Patient was advised to shave his beard hair and to avoid brushing completely. On follow-up, the patient was symptomatically better. Based on this, TNof the beard was confirmed.

Juvenile type II Waardenburg syndrome: a rare case report in Kerala

Abstract: Rare diseases are many in number but their treatments are less, as most of these rare diseases are genetical and there is no complete cure for a genetic disorder. Waardenburg syndrome (WS) is one among that type of rare genetic disorder thus the treatment is limited but the number of cases are increasing. This was the case report of a newborn baby showing major symptoms of WS. The patient got it through paternally. To make a final conclusion, various diagnostic tests were conducted including the family history as the patient's father had premature grey hairs and white patches on the body. Even though there is no complete cure for this disease condition, the sign and symptoms can be controlled before making it into a major disability. This case report typically dealt with the major types, clinical presentation, diagnosis and supportive therapy for a patient diagnosed with WS. Also showed the crucial role of consanguineous parents on this syndrome because the children affecting this rare syndrome are increasing. This report showed that further studies are required to check how the colour of the hair is changing in WS patients and what is happening to the gene involved in the production of melanin. Also, studies are required the find why WS typically affecting the major sensory organs such as eyes, ears, nose and skin.

A clinical study on linear dermatoses at a teriary care teaching hospital in Davangere

Abstract: Background: Skin lesions present with innumerable patterns like discoid, petaloid, arcuate, annular, polycyclic, livedo, reticulate, target, stellate, digitate, linear, serpiginous and whorled. Most of the linear lesions follow the Blaschko’s lines. Aim was to study the incidence of linear dermatoses, the age and sex incidence, various types of clinical presentation, various sites of distribution and their clinical correlation. Methods: Detailed history including family history, History of disease documented with clinical examination. After counselling and after recording their consent for the test, skin biopsy along with routine investigations was done wherever needed and the results were evaluated. Results: Lichen striatus was seen in 29.91% followed by linear herpes zoster in 24.7%, linear lichen planus in 18.22%, linear verrucous epidermal nevus in 14.01%, segmental vitiligo in 3.73%, nevus depigmentation in 2.33% and others. Maximal cases were asymptomatic and reported for cosmetic reason. Intense itching was the main reason to bring the lichen planus patients and few cases of the lichen striatus patients for treatment. Conclusions: Lichen striatus was found to be more common, female preponderance. Majority of patients showed unilateral distribution more on the extremities. Histopathological correlation shows the importance of histopathology which ultimately changes the management in any given condition.

Hair: more than just an appendage

Abstract: Hypotrichosis is a relatively common feature of a number of complex hereditary syndromes. However, the isolated variant, called hereditary hypotrichosis simplex (HHS), is uncommon. We present a 4 years old child and his father who presented to us with features suggestive of HHS. No other associated ectodermal and systemic abnormalities were noted.

Dermatosis of scalp and hair disorder: an observational study in a hilly state of North-East India

Abstract: Background: The skin of the scalp has several unique features that aid in its critical role of protecting the head. These unique features of the scalp make it susceptible to superficial mycotic conditions, parasitic infestation and inflammatory conditions. These disease processes of the scalp can have significant overlap in clinical symptomatology. The aim was to observe the clinical profile of scalp dermatosis and hair disorder at a tertiary care hospital. Methods: This was a cross sectional observational study which was carried over a period of 1 year 5 months from August 2019 to November 2020. A total of 76 patients were included in the study, who visited dermatology OPD of SMIMS, Sikkim. Results: This study included 76 patients of clinically and histopathologically diagnosed cases of scalp dermatosis and hair disorder, 47 males and 29 females. A total of 18 different dermatoses were observed in this study. The most common disorder was seborrheic dermatitis, which accounted for 18.4 %, followed by androgenetic alopecia in 17% and alopecia areata in 15% cases in the present study. Conclusions: The article provides an overview of the most common scalp disorders, which we have observed in our study.

Demographic profile of patients treated for melasma with glycolic acid and trichloroacetic acid: an institutional experience

Abstract: Background: Melasma is an acquired disorder of hyperpigmentation characterised by forehead, cheeks, around eyelids and chin mostly in the sun-exposed areas of the skin. The etiology for melasma is not clear, various factors like genetic or hormonal influences the cause. The aim was to understand the demographical distribution and epidemiological pattern of pigmentation in melasma patients. Methods: A total of 50 patients were participated in the present study at department of dermatology of Mamata medical college and hospital, Khammam over a period of one year. Results: The mean age of patients with melasma was 33.84±5.76 years, with the youngest and oldest being 20 and 40 years with female preponderance, with a male to female ratio of 1:9. The maximum number of patients educated up to middle school level (38%) followed by primary school. The maximum number of individuals participated in the present study were housewife’s and out of 50 individuals 92% patients in the present series were married whereas family history of melasma was noted only 16% of the melasma patients. Conclusions: The present observations demonstrates that the melasma is a female predominant, affecting young adults, etiological observations like sunlight, married, pregnancy, indoor, family history followed by cosmetics plays an important role in the melasma.